Case Number : Case 2596 - 18 June 2020 Posted By: Saleem Taibjee

Epithelioid Angiosarcoma. 

agree with epithelioid AS

Agree with epithelioid angiosarcoma

Angiosarcoma

First thought epithelioid angiosarc

Any previous radiotherapy Saleem?

This is a recent case. Yes, correct, the patient did indeed receive prior radiotherapy for breast cancer, and this is an epithelioid variant of angiosarcoma.

Interestingly, the patient had a previous biopsy which I also reported, which was non-diagnostic (even after review). It's not the first time I have come across this scenario of a non-diagnostic first biopsy in angiosarcoma, so sampling/biopsy site does seem to be a pitfall, and it may best to advise a repeat biopsy in such non-diagnostic cases when the clinician queries angiosarcoma.

Also be aware of cases in which iron/haemosiderin can be a subtle clue.

In the present case in the 3rd image above there is a further clue with vasoformative areas (see close up below). Sometimes these may be at the periphery of the biopsy only.

BW

Saleem

Was the earlier non-diagnostic biopsy too superficial?  Perhaps the epithelioid element of the tumour tends to be deeper in the dermis, with sometimes only subtle, easily missed vascular alterations superficially.

Inadequate superficial "shave" biopsies is one of my bugbears!

Yes, precisely, Richard. The biopsy was performed by a breast surgeon. The paradox is that the general surgeon is often more sparing with a skin biopsy compared to the dermatologist.